Containing disease in a Syrian refugee camp in Iraq

On a hot June afternoon, 27-year-old Gharib Mohammed stands outside his tent at this camp for Syrian refugees in Iraq, shovel in hand.

Sewage and garbage have blocked the small stream that runs the length of his dusty avenue and the smell has entered his tent.

“There are some other streams but I can’t clean them all. I just clean the one in front of my home. If everybody did the same thing, the camp would be clean, but not everybody does it.”

The water running past Mohammed’s house is what is technically known as “grey” water - cooking and washing water that is not contaminated with sewage. Or at least it is not supposed to be.

Mohammed points to the septic tank behind his tent, which he says is shared by 25 families.

“In two days, it gets full [then] it overflows and mixes with the other water.”

In the three months he has been living there, government contractors have emptied the tank three times, he said. He once had to resort to paying the truck driver 5,000 Iraqi dinars (US$4.30) to empty it.

Aid agencies say overcrowded living conditions in Domiz (Duhok Province) - built for 25,000 refugees but now accommodating almost twice that number - have put refugees’ health at risk.

“Water, sanitation and hygiene facilities on the site are far from adequate, increasing the risk the camp could become fertile ground for the spread of disease,” Mahendra Sheth, regional health adviser for the UN Children’s Fund (UNICEF), which is responsible for water and sanitation activities, said at the start of summer.

In April, a number of measles cases were reported in the camp, and between mid-March and mid-May, the number of diarrhoea cases tripled, the medical charity Médecins Sans Frontières (MSF) said.

An assessment conducted by MSF in April showed “clear inequalities” in water distributions, it said in a 15 May press release. Some areas of the camp receive only four litres per person per day, MSF said, far less than the minimum 15-20 litres per person recommended in humanitarian emergencies.

“In some instances, people simply do not have access to water or sanitation,” MSF emergency coordinator Stéphane Reynier wrote. “This is simply not acceptable.”

Massoud Barzani, president of the Kurdistan Regional Government (KRG), recently accused the international community of “abandoning” the Syrian refugees in Kurdistan and asked foreign officials to bring the situation to the attention of their governments.

Overstretched

Aid agencies have vaccinated people and are trying to increase water and sanitation services in the camp, but the problem, explains Jaya Murthy, head of communications for UNICEF, is that the camp is overstretched.

“Services were only planned for [25,000] people, so when you [nearly] double that number, of course those services are stretching, which means less for everybody.”

Many irregular settlements and transit areas have emerged, he said, and some of the people on the fringes may not even have access to some of those regular services.

The differences between the original areas and the irregular and transit areas of the camp are stark. Approved tents in the first three phases of construction of the camp each have their own latrine and share one septic tank for every four tents.

In Phases 1-3, Swedish NGO Qandil contracts a waste removal company to empty tanks when families report them full. “The trucks stand by 24 hours a day,” says Salar Rasheed, Iraq programme coordinator, “so the truck is available even at night.”

But residents in unapproved tents and in some of the transit areas share one latrine between 29 to 189 people, according to a Norwegian Refugee Council (NRC) report based on February data from the UN Refugee Agency (UNHCR). In one case documented by NRC, residents had to keep using a communal latrine that was overflowing for lack of an alternative.

To address the overcrowding, the UN is working with the Kurdish authorities to allocate more land for new camps. KRG has approved the construction of two new refugee camps in the region - one in Erbil Province, scheduled to open this month, which will house 2,000 families; and one in Sulaymaniyah, designed to hold 1,500 families.

Although there were initial hopes to install proper sewage systems in both camps, the cost of doing so - around $5 million dollars each - was prohibitive given the region’s limited budget.

“It can be done,” says Qandil’s Rasheed, “but it costs a lot of money.”

A neglected crisis?

In June, the UN issued the largest appeal for funding in history to address humanitarian needs related to the Syrian crisis. Included is a request for $37 million for water, sanitation and hygiene services in Iraq, including ensuring safe water and sanitation throughout Domiz.

Gharib Mohammed unblocks the stream outside his tent. Open gray water channels in Domiz Camp are often contaminated with garbage and sewage

But aid workers say the international community has neglected the Syrian crisis in Iraqi Kurdistan, focusing instead on Jordan and Lebanon, where donors perceive the needs to be higher. Aid agencies in Iraq have received just 14 percent of the funding requested for their humanitarian response to Syrian refugees in 2013. As a percentage, and also by raw figures, this makes Iraq the least-funded of the four countries in the Regional Response Plan that border Syria.

“The Syrian refugees have the same right to vital assistance, wherever they flee to seek protection. However, it has - unfortunately due to various political and economic reasons - been very difficult to attract funding to the projects in Iraq, and the refugees are the ones paying the price,” said Toril Brekke, acting secretary-general of the Norwegian Refugee Council, which just published a report on how the international community is “failing” Syrian refugees in the Kurdish region of Iraq.

Rising disease risk

In the meantime, government authorities and aid agencies are trying to prevent a disaster with the little funds they do have. With temperatures rising (in July, they often surpass 40 degrees), the risk of water-borne diseases is increasing.

“Over several weeks [the number of reported cases of diarrhoea] went down but it can come up at any time so ensuring access to sanitation and safe water is absolutely critical,” said UNICEF’s Murthy. “So as new people keep coming and settling in these irregular areas, we have to be really on top of it to ensure that [the water supply] is properly maintained and those services are delivered to everybody. Otherwise contagious diseases like diarrhoea and other water-borne diseases can catch very quickly.”

The Duhok Province authorities provide a water network to the original settlements and, for the time being, water trucks take care of the rest of the camp.

Thanks to a grant of $4.5 million from the Japanese government, UNICEF is currently planning to lay a pipe network in one of the newest areas of the camp, Phase 7.

UNICEF and NRC are about to start a water monitoring project, checking that the levels of chlorine are adequate.

As well as putting together a cholera prevention plan, UNICEF and MSF have started to send health and hygiene promoters around the camp, tent to tent, to teach families how to minimize the risk of disease and infection. It is particularly important to help residents used to living in modern urban environments to adjust to their new conditions, Murthy said.

“Hygiene promotion is one area that we really need to critically scale up. It’s really, really our priority area.” There are 64 hygiene promoters working in Domiz, “but we need to double or triple that.”

Click here for more IRIN reporting on how a lack of access to water, sanitation and proper hygiene is threatening Syrians and others across the region.